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Watch Carefully (one)pentobarbital will decrease the level or effect of fentanyl intranasal by influencing hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Check Intently. Coadministration of fentanyl with CYP3A4 inducers could lead on into a reduce in fentanyl plasma concentrations, lack of efficacy or, quite possibly, progress of the w